Childbirth isn’t easy, and many women don’t realize there are several options when it comes to birthing positions. Find out what position might work best for you.
Think back to the last time you saw a birth scene on TV or in a movie. How was the woman positioned? Chances are, whether the woman was giving birth in a hospital or a cab, she was on her back. In reality, there are a variety of labor and birth positions that women can—and do—use.
Why We Birth on Our Backs
In the US, most women have their babies in a recumbent position, meaning lying down, according to the Journal of Family Practice. “From my experience, I don’t believe women necessarily prefer the recumbent position,” explains Jill Alliman a certified nurse midwife and the director of the Women’s Wellness and Maternity Center in Madisonville, Tennessee. “It is just that, in most hospitals, women aren’t given the options of an active and upright labor and birth.”
A study conducted by Homebirth Australia and reported in their February 1994 newsletter noted that of women who were free to move around during childbirth, 82 percent chose positions other than on their back (nonrecumbent). “The position most commonly assumed by experienced birthers was hands and knees (28.2 percent); the one most frequently used by first-time birthers was squatting (36.2 percent).
A French study done by Alliance Francophone pour l’Accouchement Respecté (AFAR), or the French-speaking Alliance for the Respected Childbirth, in May of 2005 confirmed that upright or ambulatory birth positions are favorable for a variety of reasons, including fetal oxygenation. The study goes on to say, “the purported advantages of ambulation in the upright position during labor include enhancement of the pelvic diameter, increased coordination, frequency and intensity of uterine contractions, increased maternal comfort and satisfaction and improved neonatal outcome (higher Apgar scores), decreased perception of labor pain, decreased need for labor augmentation, and decreased requirements for labor analgesia.”
The study concludes that although the effects of ambulatory labor on the progress of labor is still under investigation, the ability to walk to the bathroom and change positions in bed are compelling enough as reasons in support of semi recumbent positions, movement during labor, and walking epidurals.
Erica Lyon, Director of Realbirth, a center that offers childbirth classes and support to pregnant women and mothers in New York City, explains some of the disadvantages to birthing in a recumbent position. “It’s just basic physics. When you’re lying down, you aren’t using gravity to work with the contractions to birth the baby. You lose the efficiency of the contractions.”
Women may also feel less in control, continues Lyon. “To have your feet completely off the ground and not be able to see what’s going on, may make women feel even more vulnerable than they already feel.”
Benefits of Upright Labor
Laboring in active positions such as walking, squatting, or on a birthing ball has several potential advantages. As Lyon points out, laboring in an upright position means that the baby is being drawn down by gravity. Simply being upright can help the body maximize the power of contractions. With more efficient contractions, delivery time may be reduced.
Alliman adds that a woman should try several positions during labor. “The combination of gravity and changing positions frequently helps the baby’s head move lower in the pelvis and into the best position for birth.” For example, when a laboring woman is on a birthing ball or squatting, her pelvic opening is one to two centimeters larger than when she is lying down, says Alliman.
Women who deliver in nonrecumbent positions also tend to have less vaginal tearing and episiotomies. “This is because of less stress on the vaginal opening [and your back] in these positions,” Alliman explains.
Another bonus of nonrecumbent positions is that a woman’s backbone is more aligned and her blood circulation is better, adds Lyon.
Positions You Can Try for Labor and Childbirth
Penny Simkin, Janet Whalley, and Ann Keppler, authors of Pregnancy, Childbirth and the Newborn: The Complete Guide, recommend the following positions for labor and childbirth:
Walking and Standing: Gravity will work with contractions as you stand or walk through labor pains.
Leaning: Lean against a wall, bed, or partner to support yourself.
Rocking: Gently moving your body back and forth may help you relax. You could rock in a chair or even against your partner.
Hands and Knees: This position can help relieve back pain.
Squatting/Sitting on a Birthing Ball: This position helps the pelvic opening stretch wider.
Side-Lying: Though similar to the recumbent position, lying on your side on the hospital bed can bring relief without working against gravity.
Hands and Knees: This position can relieve the pressure of back pain.
Squatting: Most women are not accustomed to squatting, and you may need a partner to help you stay in this position. Many hospitals and birth centers have a birthing bar at the end of the bed to help you balance.
Side-Lying: This familiar position allows you to rest between contractions.
Semi-Sitting: For this position, sit on the bed, bringing your legs toward yourself.
Lyon points out that a woman should practice birth positions by attending a birth class or reviewing pregnancy books and trying positions out at home. She urges women to dismiss the idea that one position works for everyone. “The idea that every woman should give birth in the same position is like saying that everyone should have sex in the same position. Different positions work for different women.”
Keep in mind there are several variations of each position and you can also combine methods, for example squat or lean while in the shower.
Medication and Semi-Recumbent Positions
Not all pain relief medications work with various laboring and birthing positions. Narcotics can make women dizzy or drowsy so that it is difficult to move around. Epidurals can cause immobility, making it less likely that a woman will be able to use a nonrecumbent position for birth. In addition, epidurals are administered through an IV attached through a small tube in a woman’s back; both the woman and the baby must be constantly monitored, according to Dr. William Camann, MD, and Kathryn J. Alexander, authors of Easy Labor. Some hospitals have policies against a woman getting up once she has had an epidural.
Finding the Right Doctor to Match Your Birthing Goals
Before deciding on a labor or birthing position, make sure your OB-GYN or midwife will support your decision. “You should discuss your birthing desires as soon as possible to get a sense for the range of possibility that a practice will handle,” says Lyon. “Some are very relaxed while other practices have very rigid ideas of what they will allow. It can be devastating to find out two weeks before your due date that you don’t have any choice.”
To avoid this, Lyon suggests talking to your doctor or midwife early in pregnancy about birth positions and not just in generalities: “Don’t be afraid to ask questions and be specific. If you want to deliver naturally and the hospital that your doctor delivers at has high epidural rates, ask how he or she manages that.”
Ready to Deliver?
While labor and childbirth may sound overwhelming, education is key. Talk to your healthcare provider about your needs and find classes that will help you meet your goals. Try out different positions at home before the big day to learn what might work best for you.